________________________________________________________________ Cultural Humility in Healthcare
When Linda returns to counseling several weeks later, she again admits to not following through on Janine’s suggestions. She is still stressed. Janine is frustrated at the lack of progress but continues to try to help Linda with her stress through offering a variety of self-care options. Linda continues to agree to try a variety of techniques and agrees to continue to meet, but with little enthusiasm. Discussion: 1. Cultural forces: A class mismatch (middle-class clinician vs. working-poor patient), rural resource scarcity, and healthcare power dynamics shaped their interaction, alongside gendered caregiving expectations and stigma around mental health and smoking. Differences in health literacy, transportation/financial barriers, and communication norms likely made Janine’s guidance feel out of touch with Linda’s realities. 2. Exploring stress: Start with Linda’s agenda and map her top stressors, supports, and constraints, using brief validated tools (PHQ-9, GAD-7, PSS-10, AUDIT-C, IPV screen). Assess sleep, pain, function, meds burden, finances/transport/childcare, safety, and strengths; then co-create one small, specific goal using reflective listening and teach-back. 3. Middle-class bias: The techniques assumed discretionary time, money, privacy, and flexible work (e.g., journaling, classes, elaborate self-care) and emphasized individual responsibility over structural barriers. They also leaned on compliance language and abstinence-focused smoking advice, prioritizing insight over concrete, resource-aware problem-solving. 4. Actions as NP: Use cultural humility, let Linda set the priority, and co-design a realistic micro-goal (e.g., med access first; cut one cigarette/day; 5-minute breathing during routine tasks). Provide low-cost supports (quitline, samples), address SDOH via targeted referrals (social work, financial/transport aid), simplify meds (90- day generics, med sync), screen/treat depression/anxiety, use trauma-informed communication, and offer flexible follow-up. Case Study Continued: It is not surprising that Linda sought help from the clinic doctor first because her poverty likely afforded her little opportunity to seek therapy. Fortunately, the clinic she went to had counseling services available and Linda was able to meet with a therapist. Although Janine is empathetic and caring, she fails to make headway with Linda’s stress and is frustrated by Linda’s lack of follow-through. Janine neglects to thoroughly explore the role that poverty plays, both in Linda’s stress response and in her ability to pursue stress reduction in the way that someone with more resources might be able to. Linda does not have the luxury of time, and smoking provides her with quick relief. Although Linda may want to stop smoking, it is unlikely that she has the time to devote to smoking-cessation classes. Janine might have wanted to work with Linda on some of the stressors in her life that require advocacy outside the office. For example, Linda’s inadequate diet may be the result of not being able to afford enough
food. Janine could have explored this with Linda and helped Linda access various governmental and nonprofit programs to help her obtain sufficient food. Although Linda agreed to continue to work with Janine, she may have done so because she does not feel that she had an option.
CONCLUSION When working with patients from diverse backgrounds, healthcare professionals must be willing to continuously look at personal dimensions of diversity and at how those dimensions affect their worldview and their view of their patients. Thus, healthcare professionals enter the professional relationship with a solid base of self-knowledge and a continuous commit- ment to critical self-reflection. Healthcare professionals also enter into patient interactions with an open mind and curiosity regarding the patient’s lived experience. Healthcare profes- sionals do not pretend to know or understand each patient’s unique combination of facets of diversity and do not assume that the patient will behave or believe in any way based on those facets of diversity. In fact, the culturally humble health- care professional “cultivate(s) openness to the other person by regulating one’s natural tendency to view one’s beliefs, values, and worldview as superior, indeed, the culturally humble healthcare professional strives to cultivate a growing awareness that one is inevitably limited in knowledge and understanding of patients’ backgrounds” (Hook et al., 2016, p. 152). This stance of openness and equality provides an environment for healthcare professionals to enter respectful and equitable partnerships with patients. Moreover, the culturally humble healthcare professional considers how the societal structures in the United States serve to oppress some individuals and groups while empowering other individuals and groups. Patients are affected by the inequality within the United States. They are affected by living in a society where racism, sexism, classism, homophobia, and discrimination based on a variety of other diverse identities, including disability and gender identity, are expressed in a multitude of ways; this discrimination obstructs access to resources and opportunities and impedes interpersonal relationships. The power imbalances within society and institutions and as experienced by patients require the culturally humble healthcare professional to take an active role in righting those imbalances. Cultural humility chal- lenges healthcare professionals to ask difficult questions and encourages them not to reduce patients to a preconceived set of cultural norms that have been learned in trainings about diversity and difference (Salahshurian and Moore, 2024). Finally, the culturally humble healthcare professional will engage in lifelong learning that supports effective practice.
WORKS CITED https://qr2.mobi/cultural-humilty-hc
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EliteLearning.com/Social-Work
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